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Reimbursement / Regulatory

CMS Publishes 2017 Final Rule Increasing Outpatient Facility Reimbursement for MIS SI Joint Fusion -

The U.S. Centers for Medicare & Medicaid Services (CMS) issued its 2017 Final Hospital Outpatient Prospective Payment System (HOPPS) and Ambulatory Surgical Center (ASC) payment rule for MIS sacroiliac joint fusion. New payments are effective January 2017.

The final payment rule shows that AMA CPT® code 27279 has been assigned to APC 5116 and provides an increased Medicare national average hospital outpatient payment from $10,538 to $14,698, up $4,160 (+40%) over the current payment amount.  In the ASC, the new Medicare national average payment will increase from $7,887 to $12,553, up $4,666 (+59%) over the current payment amount. 

SI-BONE has developed its iFuse Implant System® as a minimally invasive surgical device indicated for fusion for certain disorders of the sacroiliac joint.

iFuse is the only MIS SI joint fusion system cleared by FDA with an indication citing clinical studies that demonstrate improved pain, function and quality of life out to 12 months post-implantation. iFuse is reported to be the only commercially available MIS SI joint fusion device in the U.S. with published clinical evidence demonstrating safety and effectiveness for SI joint fusion.  

Sources: SI-BONE, Inc.; ORTHOWORLD Inc.

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